Evaluation and comparison of 11C-choline uptake and calcification in aortic and common carotid arterial walls with combined PET/CT

Purpose Inflamed atherosclerotic plaques may rupture and cause acute myocardial infarction, stroke and other thrombotic events. Early detection of these unstable plaques could, in many cases, prevent such potentially fatal events. C-11-choline or F-18-labelled choline derivatives for visualizing the synthesis of phospholipids, are promising markers of plaque inflammation with potential advantages over F-18-FDG. Their potential for plaque characterization in humans is, however, unclear. In this study the prevalence and distribution of C-11-choline uptake in the aortic and common carotid arterial walls of elderly male patients was evaluated with combined PET/CT. Additionally, the localization of radiotracer uptake and calcification was correlated in various vessel segments. Methods Image data from 93 consecutive male patients between 60 and 80 years old who had undergone whole-body C-11-choline PET/CT assessment for prostate cancer were evaluated retrospectively. C-11-choline uptake and calcification were analysed qualitatively and semiquantitatively and compared. Results C-11-choline uptake was found in 95% of patients, calcification in 94% throughout all vessel segments. In 6% of the patients radiotracer uptake was colocalized with calcifications, whereas less than 1% of calcification sites showed increased radiotracer uptake. Conclusion Both C-11-choline uptake and calcification in the aortic and common carotid arterial walls are common in elderly men. Radiotracer uptake and calcification are, however, only rarely colocalized. C-11-choline has the potential to provide information about atherosclerotic plaques independent of calcification measurement.